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Chapter 15

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University of Toronto St. George

Chapter 15 • Eating disorders: traditionally more prevalent in women though recent emphasis on men having a superfit look; driving force to be more attractive, increase self- esteem, lose weight; almost half of grade 10 girls indicating they were on a diet or needed to lose weight; problems can start in elementary school; men more likely to have histories of being overweight or bingeing before disorders develop • Anorexia nervosa: pursuit of thinness that leads people to starve themselves; can develop elaborate rituals around food o Restricting type: people simply refuse to eat as a way of preventing weight gain; attempt to go for days without eating anything; eat very small amounts of food each day; more likely to mistrust others and deny they have a problem o Binge/purge type: people periodically engage in bingeing or purging behaviours; do not eat large amounts of food in binge; different from bulimia in that people with AN continue to be at least 15% below a healthy body weight and develop amenorrhea; more likely to have problems with unstable moods, impulse control, self-mutilation, alcohol • Diagnosis: person refuses to maintain a body weight that is healthy and normal for their age/height; weight must be 15% below minimum healthy weight; intense fears of becoming fat; distorted images of their bodies; self-evaluations hinge on weight and control over eating; causes chronic fatigue but are still driven to exercise excessively o Amenorrhea: weight loss in women and girls that causes them to stop having menstrual periods; absence of three consecutive menstrual cycles required for diagnosis • Prevalence: 1% of people will develop anorexia at sometime in their lives; between 90-95% of people diagnosed are female; white women more likely; usually begins in adolescence; half the women who develop this recover fully 10 years after treatment but remainder continue to suffer for eating related or other psychopathologies • Prognosis: physiologically deadly; death rate between 5-8%; high suicide rates; cardiovascular complications (brachycardia, arrhythmia and heart failure); bone strength (low estrogen levels); kidney damage and impaired immune functioning • Bulimia nervosa: cycle of bingeing (uncontrolled eating) follow by extreme behaviours to prevent weight gain; sense of lack of control over eating during binge; binge eating and purging occur on average at least twice a week for three months; self-evaluation unduly influence by body shape and size; do not show gross distortions in body images like people with AN; no weight criteria for BN o Binge: occurring in a discrete period of time (ex: hour or two) and involving eating an amount of food that is definitely larger than most people would eat during a similar period of time in similar circumstances; tremendous variation o Purges: inappropriate behaviours to prevent weight gain, like self-induced vomiting, misuse of laxatives, diuretics, enemas or other meds, fasting or excessive exercise o Purging type: use self-induced vomiting or purging medications; cycle of bingeing and purging/other compensatory behaviours to control weight o Non-purging type: use excessive exercise or fasting to control weight but don’t purge; easier to hide • Prevalence: lifetime is 1.1% for females and 0.1% for males; symptoms quite common among adolescent and young adult women; frequency of binge eating not an important criterion for the disorder; onset between 15-29; most people overweight or of normal weight o Partial-syndrome eating disorders: behaviours that smack of anorexia or bulimia but don’t meet the full criteria; don’t binge multiple times a week; not a full 15% underweight; judge themselves based on weight; just as likely to have psychological problems (suicide, depression, anxiety); almost 90% had psychiatric disorders in their 20s; lower self-esteem, poor social relationships, poor physical health • Prognosis: imbalance in electrolytes, resulting from fluid loss following excessive chronic vomiting, which can lead to heart failure; laxative and diuretic abuse; tends to be a chronic condition; years of unremitting symptoms; factors associated with a more persistent course include childhood obesity, excessive valuation of shape and low weight, increasing dietary restraint and high level of social maladjustment • Cultural and historical trends: arguments that these are culture bound syndromes, occurring primarily in wealthy developed countries in which food is abundant and thinness is highly valued; prevalence has increased over recent decades; meta-analysis revealed only modest evidence of cultural or historical differences for AN; fast for religious reasons or because of stomach discomfort; prevalence for BN does seem to vary substantially across cultures and time; bingeing requires abundant food • Binge eating disorder: regularly binge but do not engage in behaviours to purge what they eat; not one of the officially recognized DSM disorders; provisional DSM diagnosis; eat a large amount of food in a short time and do this continuously throughout the day or engage in discrete binges on large amounts of food; often significantly overweight and ashamed o Prevalence: approx. 1-3% of the general population has the disorder; more common in women; high rates of depression, anxiety, alcohol abuse and personality disorders; course of this disorder more favourable than AN/BN but a subset of people do have it chronically • Biological theories: tend to run in families; 48-74% of variability in the disorder due to genetic factors; evidence of imbalances in or dysregulation of neuro- chemicals involved in hypothalamic system (dopamine, cortisol, insulin) or by structural or functional problems in the hypothalamus, leading to trouble accurately detecting hunger or to stop eating when full for AN; deficiencies in serotonin cause people with BN to crave carbohydrates; may be consequences, not causes, of the disorder • Societal pressures and cultural norms: pressures to be thin and attractive; necessity for certain psychological factors to come into play o Standards of beauty: ideal shape for women has become thinner over past 45 years; thinness more valued/encouraged in women explaining majority of sufferers being female; increases in depression, shame, gui
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